Healthcare Provider Details

I. General information

NPI: 1083274922
Provider Name (Legal Business Name): COLLEEN T FRASER CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN M THOMAS

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 AIRPORT WAY S
SEATTLE WA
98134-1618
US

IV. Provider business mailing address

PO BOX 102
MERCER ISLAND WA
98040-0102
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO60946163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: